Citation Nr: 9931745
Decision Date: 11/09/99 Archive Date: 11/19/99
DOCKET NO. 98-08 446A ) DATE
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On appeal from the
Department of Veterans Affairs Regional Office in Hartford,
Connecticut
THE ISSUE
Entitlement to service connection for Raynaud's disease.
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
K. Johnson, Associate Counsel
INTRODUCTION
The veteran served on active duty from August 1991 to August
1997.
This matter came to the Board of Veterans' Appeals (Board)
from an October 1997 decision of the Department of Veterans
Affairs (VA) Regional Office (RO) in Hartford, Connecticut,
which denied the claim of service connection for Raynaud's
disease. In May 1998, VA received the veteran's notice of
disagreement, and a statement of the case was issued. In
June 1998, the veteran filed his substantive appeal, which
included his request for a personal hearing. In May 1999,
the veteran appeared at the RO and testified before the
undersigned. He was assisted at the hearing by a member of
VA's Veterans Services Division.
FINDINGS OF FACT
1. There is competent medical evidence of a current
disability affecting the veteran's extremities, which may be
Raynaud's disease.
2. There is evidence that during and after service, the
veteran has experienced symptoms consistent with Raynaud's
phenomena when exposed to extreme cold.
CONCLUSION OF LAW
The claim of entitlement to service connection for Raynaud's
disease is well grounded. 38 U.S.C.A. § 5107(a) (West 1991);
Caluza v. Brown, 7 Vet. App. 498 (1995), aff'd, 78 F.3d 604
(Fed. Cir. 1996) (per curiam) (table).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
The Board finds that the veteran's claim of service
connection for Raynaud's phenomena is well grounded. 38
U.S.C.A. § 5107(a) (West 1991). That is, the claim presented
is plausible. Therefore, VA has a duty to assist a claimant
in the development of facts pertinent to his or her claim.
38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a)
(1999). From a careful review of the evidence in this case,
the Board has determined that there is additional development
that must be completed by the RO in order to fulfill this
statutory duty prior to appellate review of the veteran's
claim, which will be addressed in the REMAND portion of this
decision.
Here, there is evidence that at the time of his separation
examination in June 1997, the veteran reported that he
experienced poor circulation in his extremities and sore
joints during service, but he did not seek medical treatment
for those problems. The examiner commented that the symptoms
were consistent with Raynaud's phenomena of the 1st and 2nd
digits of both hands, and that the condition occurs when
exposed to the extreme cold. The Board finds that the
separation examination of June 1997 is competent medical
evidence tending to show that the veteran currently suffers
from a disorder that affects his hands, that the condition
began during service, and that it has continued. The Board
also finds that the veteran's statements and testimony that
he noticed the symptoms when exposed to the cold are
sufficient to show that he noticed the symptoms during those
periods, including the period after his separation from
service.
ORDER
The claim of entitlement to service connection for Raynaud's
disease is well grounded. To this extent only, the appeal is
granted.
REMAND
A VA examination was conducted in November 1997. Initially,
the claims folder was not available for the examiner's
review. On examination, there was no evidence of Raynaud's
phenomena, and the examiner concluded that the diagnosis of
the condition could not be confirmed. After reviewing the
service medical records, the examiner reported that the
comments made in June 1997 did not provide an actual
description and there was no other reference to the diagnosis
in the records.
During his hearing before the undersigned in May 1999, the
veteran and his representative argued that the November 1997
VA examination was deficient. It was specifically noted that
the examiner did not perform tests that would either confirm
or rule out a diagnosis of Raynaud's disease.
Since the Board has found this claim to be well grounded, VA
has a duty to assist, which includes conducting a thorough
and contemporaneous medical examination. Proscelle v.
Derwinski, 2 Vet. App. 629, 632 (1992); Green v. Derwinski, 1
Vet. App. 121, 124 (1991). It is clear that during service
the veteran suffered from some sort of condition that affects
his extremities, and that it has continued since that time.
At this point, it is not clear what condition the veteran has
given the comments made in the service medical records and
the VA examination report. The Board points out that
questions involving the presence of disease involve
diagnostic skills and are within the realm of medical
experts. Espiritu v. Derwinski, 2 Vet. App. 492 (1992).
Therefore, another VA examination is in order.
The veteran has not alleged, nor do the service records
indicate, that he is a "Persian Gulf veteran" as defined at
38 C.F.R. § 3.317(d) (1999). As such, consideration of this
regulation (concerning undiagnosed illnesses) and a special
VA examination under recently promulgated guidelines is not
warranted.
In view of the foregoing, and in order to fully and fairly
evaluate the veteran's claim, the case is REMANDED to the RO
for the following development:
1. The RO should obtain records of VA
and non-VA treatment the veteran has
received for the condition currently
referred to as Raynaud's phenomena, since
his separation from service. The
necessary authorization should be
obtained in order to secure private
medical records. After all the pertinent
records have been obtained, they should
be associated with the claims folder.
2. The veteran should be afforded a VA
examination to for the purpose of
ascertaining the diagnosis and severity
of the condition claimed as Raynaud's
disease, which he states affects his
extremities when exposed to the cold. If
it is not medically feasible to make such
a determination, the examiner should
clearly state that on the written report.
The examiner should integrate the
previous examination findings and
diagnoses with current findings to obtain
an accurate picture of the disability at
issue. All special studies and tests,
which, in the opinion of the examiner,
are reasonably necessary to complete the
examination and prepare the medical
opinions, should be accomplished. The
examiner is requested to indicate the
reasons for his or her opinion. The
claims folder and a copy of this remand
must be made available to the examiner
for review in conjunction with the
examination, and the examiner should
acknowledge such review in the
examination report.
3. The RO should readjudicate the issue
on appeal here. If the determination
remains adverse to the veteran, he
should be provided a supplemental
statement of the case that includes a
summary of additional evidence
submitted, any additional applicable
laws and regulations, including those
covering presumptive disorders, and the
reasons for the decision. The veteran
should be afforded the applicable time
to respond.
Thereafter, subject to current appellate procedures, the
case should be returned to the Board for further appellate
consideration, if appropriate. The appellant has the right
to submit additional evidence and argument on the matter or
matters the Board has remanded to the regional office.
Kutscherousky v. West, 12 Vet. App. 369 (1999).
This claim must be afforded expeditious treatment by the RO.
The law requires that all claims that are remanded by the
Board of Veterans' Appeals or by the United States Court of
Appeals for Veterans Claims for additional development or
other appropriate action must be handled in an expeditious
manner. See The Veterans' Benefits Improvements Act of 1994,
Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994),
38 U.S.C.A. § 5101 (West Supp. 1999) (Historical and
Statutory Notes). In addition, VBA's Adjudication Procedure
Manual, M21-1, Part IV, directs the ROs to provide
expeditious handling of all cases that have been remanded by
the Board and the Court. See M21-1, Part IV, paras. 8.44-
8.45 and 38.02-38.03.
J. E. Day
Member, Board of Veterans' Appeals